1. Introduction
1.1. Objectives
- Demonstrate Central Media Making Laboratory (CMML) activities
- Define CMML critical needs and inform management
- Overview of CMML raw material procurement
- Understand customer request and organize media production as well as media delivery
–> Data of media production, distribution and raw materials were extracted from the Central Media Making Laboratory Management System (CMMLMS) database in comma separated value and imported to the R programming language for cleaning and analysis.
1.2. Background
The Diagnostic Microbiology Development Program (DMDP) has been working with the University of Health Sciences (UHS) in Phnom Penh, Cambodia since 2011 to provide a sustainable source of quality-controlled media such as blood culture broth bottles, agar plates, and media for identification of bacteriological agents. The media is produced and quality controlled by following guidelines for Assuring Quality of Medical Microbiology Culture Media; Clinical and Laboratory Standards Institute and Australian Society for Microbiology 2nd edition to guide development of CMML standard operating procedures and processes. In 2017, DMDP supported the expansion and renovation of premises, purchase and installation of equipment and long-term on-site technical mentoring. Care and bleeding of sheep ensured access to a sustainable source of sheep blood. Since February 2019, CMML has held ISO certification (ISO 9001:2015). The media products were included in the Ministry of Health Essential Medicines List and more than 20 customers purchased media for their routine clinical bacteriology laboratory set up.
2. Raw materials
Data extracted on: 22 Jul 2022
Raw materials are grouped by item name regardless of different brands to
discover the current stock. Rows highlighted in pink indicate that the
item’s quantity is lower than the threshold.
Note: raw data might not be up to date. It depends on the day data is
extracted from CMMLMS in the item batch listing session.
| Category | Item name | Qnt instock | Threshold | In unit |
|---|---|---|---|---|
| Antibiotic | Azithromycin 15mg | 200 | 50 | disk |
| Cefixime 5mg | 200 | 50 | disk | |
| Ceftriaxone 30mg | 0 | 50 | disk | |
| Ciprofloxacine 5mg | 250 | 50 | disk | |
| colistin | 10 | 1 | vial | |
| Cotrimoxazole 25mg | 350 | 50 | disk | |
| Gentamicin 10mg | 100 | 50 | disk | |
| Tetracycline 30mg | 250 | 50 | disk | |
| Consumables | 3M attest biological indicator | 50 | 1 | box |
| 50ml conic centrifuge tube | 20 | 200 | pack | |
| Acetic acid glacial | 2,500 | 1,200 | ml | |
| Acohol gel | 7 | 5 | unit | |
| Acohol pad | 2,000 | 5 | box | |
| Aiway needle | 55,000 | 1,000 | box | |
| Aluminum cap BHI bottle 20mm | 6,000 | 10,000 | pack | |
| Aluminum foil | 10 | 5 | box | |
| Autoclave bag 30x60cm | 1,000 | 500 | unit | |
| Autoclave bags 14L | 1,400 | 500 | unit | |
| Betadine | 2 | 4 | unit | |
| BHI glass bottle 100ml | 12,663 | 8,415 | box | |
| BHI glass bottle 50ml | 9,740 | 7,392 | box | |
| Blood bag 250ml | 155 | 100 | unit | |
| Borosilicate tube 13x100ml | 30,000 | 16,000 | box | |
| Buffer solution pH 10.00 | 250 | 250 | ml | |
| Buffer Solution pH 4.01 | 250 | 250 | ml | |
| Buffer solution pH 7.00 | 250 | 250 | ml | |
| CHAM-MATE | 24 | 10 | unit | |
| Clear scotch tape | 6 | 5 | pack | |
| Conductivity Standard 84uS/cm | 500 | 500 | ml | |
| Cotton Swab Sterile | 980 | 400 | unit | |
| Cryobox 100 wells | 10 | 5 | unit | |
| Crystal Violet | 200 | 25 | gram | |
| Glove (?) powdered | 100 | 1,000 | unit | |
| Glove (M) powder-free | 0 | 1,000 | unit | |
| Glove (S) powder-free | 0 | 1,000 | unit | |
| Gram Stain Set (5x500ml) | 1 | 1 | kit | |
| Hand towel | 8 | 24 | pack | |
| Hydrochloric Acid (HCl) | 1,000 | 500 | ml | |
| Junk Label A3 | 48 | 20 | pack | |
| KimCap 13mm | 37,000 | 16,000 | box | |
| Kovacs indole Reagent | 0 | 20 | ml | |
| Liquid hand soap | 7 | 10 | unit | |
| Loop 10ul | 5,100 | 500 | pack | |
| Loop 1ul | 4,975 | 500 | pack | |
| Microscope slides | 17 | 2 | box | |
| Na - heparinized capillary tube | 300 | 200 | box | |
| Needle 21G | 1,700 | 5 | box | |
| Neutral Red | 75 | 25 | gram | |
| Petri dish | 42,000 | 60,000 | unit | |
| Pipette plastic 3ml sterile | 500 | 500 | pack | |
| Pipette Tip sterile 1000ul | 383 | 200 | pack | |
| Pipette Tip sterile 200ul | 288 | 200 | pack | |
| Plastic bag 7x11 | 73 | 30 | pack | |
| Potassium chloride (KCl) | 250 | 20 | ml | |
| Pourite anti-bubble additive | 120 | 120 | ml | |
| Rubber stopper BHI 20mm | 5,000 | 12,000 | pack | |
| Screw cap plastic tube 12ml | 3,250 | 500 | pack | |
| Sodium chloride (NaCl) | 1,000 | 9 | gram | |
| Sodium hydroxide (NaOH) | 0 | 100 | gram | |
| Sterile screw tube 2ml | 2,650 | 500 | pack | |
| Sterilized gauze | 6 | 5 | pack | |
| Surgical Mask | 650 | 200 | unit | |
| Syringe 10cc | 600 | 200 | unit | |
| Syringe 20cc | 0 | 20 | unit | |
| Syringe 5cc | 500 | 200 | unit | |
| Dehydrated media | Amies Transport Medium | 205 | 150 | gram |
| Blood agar base | 6,092 | 1,000 | gram | |
| Brain Heart Infusion Broth | 9,384 | 19,000 | gram | |
| CLED agar | 0 | 250 | gram | |
| GC agar base | 2,746 | 500 | gram | |
| Haemoglobin powder | 1,092 | 3,000 | gram | |
| Hektoen enteric agar | 1,266 | 1,500 | gram | |
| Kligler Iron Agar | 1,647 | 800 | gram | |
| Lysine Iron Agar | 1,206 | 500 | gram | |
| MacConkey Agar | 4,500 | 10,000 | gram | |
| Mannitol Salt Agar | 3,066 | 6,000 | gram | |
| Mueller Hinton Broth | 500 | 200 | gram | |
| Mueller Hinton II Agar | 5,316 | 12,000 | gram | |
| Sabouraud 4% Glucose Agar | 500 | 500 | gram | |
| SIM medium | 775 | 250 | gram | |
| Simmons Citrate Agar | 1,669 | 250 | gram | |
| Soyabean Casein Digest Agar (TSA) | 3,908 | 960 | gram | |
| Soyabean Casein Digest Medium (TSB) | 5,917 | 200 | gram | |
| TCBS | 1,491 | 1,500 | gram | |
| Tryptic Soy Blood Agar Base No 2 | 9,536 | 13,000 | gram | |
| Tryptic Soy Broth | 1,453 | 200 | gram | |
| Trypticase Soy Agar | 0 | 960 | gram | |
| Urea agar base | 1,292 | 250 | gram | |
| Supplement | Crystal Violet 0.1% (in house) | 260 | 50 | ml |
| Gentamicin 80mg | 12 | 1 | vial | |
| Glycerol | 2,760 | 1,000 | ml | |
| Neutral Red 1% | 260 | 100 | ml | |
| Sodium Polyanethole Sulfate (SPS) | 373 | 200 | gram | |
| Urea supplement 40% | 3,450 | 400 | ml | |
| VCNT supplement | 14 | 50 | ml | |
| Vitamino supplement | 7,670 | 3,000 | ml | |
| Other | Distilled Water | 7,306,298 | 0 | ml |
| Sheep blood | 3,655 | 3,500 | ml |
Dehydrated media powder is critical for the production of
culture media. Based on media production data, we express dehydrated
media in grams to determine the consumption.
Abbreviation: ATM-Amies Transport Medium, BAB infusion-Blood agar based infusion, BAB2-Blood agar based No2, BHI-Brain Heart Infusion, CIT-Simmons Citrate agar, CLED-Cystine Lactose Electrolyte Deficient agar, GC-GC agar, HEK-Hektoen Enteric agar, KIA-Kligler Iron agar, LIA-Lysine Iron agar, MAC-MacConkey agar, MHII-Mueller Hinton agar II, MSA- Mannitol Salt agar, MTM-Modified Thayer-Martin agar, SIM-Sulfide Indole Motility, TCBS-Thiosulfate Citrate Bile Salts Sucrose agar, TSA-Tryptic Soy agar, TSB-Tryptic Soy Broth, Urea-Urea agar
3. Sheep Care
Data extracted on: 26 Jul 2022
Sheep blood is a vital supplement to support bacterial growth and to visualize hemolysis patterns. To sustain sheep blood supply for CMML, agreements are established with Resource Development International Cambodia (RDIC) and other sheep farm(s) for care, feeding, bleeding and housing of the sheep. Detail of sheep inventory
Frequency of sheep blood collection from 01 Jan - 26 Jul 2022:
| Sheep ID | Sex | Farm | Frequency |
|---|---|---|---|
| 590 | Female | RDIC | 5 |
| 739 | Male | RDIC | 5 |
| 740 | Male | RDIC | 5 |
| 983 | Male | RDIC | 5 |
| 993 | Female | RDIC | 5 |
| 518 | Male | RDIC | 4 |
| 585 | Female | RDIC | 4 |
| 593 | Female | RDIC | 4 |
| 595 | Female | RDIC | 4 |
| 732 | Male | RDIC | 4 |
| 985 | Female | RDIC | 4 |
| 991 | Male | RDIC | 4 |
| 994 | Male | RDIC | 4 |
| 998 | Male | RDIC | 4 |
| 588 | Female | EPR | 3 |
| 981 | Male | NA | 3 |
| 990 | Female | RDIC | 3 |
| 584 | Male | RDIC | 2 |
| 597 | Male | RDIC | 2 |
| 600 | Male | RDIC | 2 |
| 721 | Male | NA | 2 |
| 731 | Male | NA | 2 |
CMML performs quality control of sheep blood by monitoring packed cell volume (PCV). The acceptable range of PCV for sheep is between 24 to 45. Below is the summary of sheep with PCV out of range, not suitable for blood collection:
| Sheep ID | Collection Date | Farm | PCV |
|---|---|---|---|
| 999 | 18 Mar 2022 | EPR | 23 |
4. Media Internal Quality Control
Date: 01 Jan - 26 Jul 2022
CMML performs quality control for all batches of media before delivery
to customers. The table below summarizes quality control results. Note:
experimental media are excluded from this table.
| Media name | Pass | Fail | Total |
|---|---|---|---|
| Amies Transport Media | 4 | 0 | 4 |
| Ashdown’s Agar | 12 | 0 | 12 |
| Ashdown’s Broth | 2 | 0 | 2 |
| Blood Agar | 53 | 1 | 54 |
| Blood Culture Bottle (adult) | 52 | 0 | 52 |
| Blood Culture Bottle (child) | 8 | 0 | 8 |
| Chocolate Agar | 36 | 0 | 36 |
| Cystine Lactose Electrolyte Deficient Agar (CLED) | 3 | 0 | 3 |
| GC agar +1% growth supplement | 6 | 0 | 6 |
| Hektoen Enteric Agar | 9 | 0 | 9 |
| Kligler Iron Agar | 10 | 0 | 10 |
| Lysine Iron Agar | 10 | 0 | 10 |
| MacConkey Agar | 25 | 0 | 25 |
| Mannitol Salt Agar | 14 | 1 | 15 |
| Modified Thayer-Martin Agar | 2 | 0 | 2 |
| Mueller Hinton II Agar | 32 | 0 | 32 |
| Sheep Blood Mueller-Hinton Agar | 8 | 0 | 8 |
| Simmons Citrate Agar | 7 | 0 | 7 |
| Sulfide Indole Motility Medium | 6 | 0 | 6 |
| Thiosulfate Citrate Bile Salts Sucrose Agar (TCBS) | 6 | 0 | 6 |
| Trypticase Soy Agar | 1 | 0 | 1 |
| Trypticase Soy Broth | 2 | 0 | 2 |
| Trypticase Soy Broth + 20% glycerol | 4 | 0 | 4 |
| Urea Agar | 11 | 0 | 11 |
| Total | 323 ( 99.4 %) | 2 ( 0.6 %) | 325 |
5. Media production
We compute media production data from 1 Jan - 19 Jul 2022
6. Media distribution
Media distribution is calculated from 1 Jan - 22 Jul 2022
The bubble in the map shows the different sites of customers orders and the size of the bubble indicates the quantity in units. In cooperation with interactive maps, you can zoom in and click on a map to see data plotting.
| Customer Name | Jan | Feb | Mar | Apr | May | Jun | Jul | Total |
|---|---|---|---|---|---|---|---|---|
| Siem Reap | 2,100 | 2,150 | 1,910 | 2,230 | 2,780 | 4,000 | 3,100 | 18,270 |
| Takeo | 2,060 | 0 | 3,920 | 0 | 1,980 | 3,480 | 1,630 | 13,070 |
| Battambang | 1,148 | 730 | 1,510 | 1,220 | 1,020 | 1,550 | 2,410 | 9,588 |
| Kossamak | 740 | 840 | 900 | 1,190 | 1,340 | 1,400 | 1,680 | 8,090 |
| KSFH | 790 | 0 | 1,680 | 790 | 1,510 | 1,310 | 860 | 6,940 |
| Kampong Cham | 900 | 650 | 810 | 1,310 | 590 | 1,240 | 880 | 6,380 |
| NPHL | 600 | 1,110 | 150 | 440 | 1,380 | 0 | 860 | 4,540 |
| BOM | 470 | 810 | 1,000 | 950 | 710 | 10 | 160 | 4,110 |
| Sunrise Hospital | 540 | 630 | 130 | 540 | 500 | 450 | 260 | 3,050 |
| BTB_AFRIMS | 200 | 260 | 410 | 840 | 160 | 550 | 607 | 3,027 |
| SHCH | 791 | 309 | 200 | 200 | 520 | 450 | 449 | 2,919 |
| Biobykin | 250 | 280 | 310 | 190 | 230 | 350 | 290 | 1,900 |
| National Pediatric Hospital | 304 | 0 | 0 | 103 | 497 | 300 | 500 | 1,704 |
| Amatak Laboratory | 214 | 0 | 120 | 80 | 0 | 130 | 80 | 624 |
| CMML | 40 | 0 | 290 | 27 | 99 | 71 | 10 | 537 |
| Svay Rieng | 0 | 270 | 0 | 0 | 0 | 180 | 0 | 450 |
| Pro Laboratory | 120 | 0 | 70 | 0 | 70 | 0 | 90 | 350 |
| International Standard lab | 150 | 0 | 150 | 0 | 0 | 0 | 0 | 300 |
| Royal Phnom Penh hospital | 270 | 0 | 0 | 0 | 0 | 0 | 0 | 270 |
| Olympia Medical Hub | 0 | 0 | 0 | 0 | 190 | 0 | 0 | 190 |
| US NAMRU-2 | 0 | 0 | 110 | 0 | 0 | 0 | 0 | 110 |
| Central Laboratory | 0 | 0 | 0 | 0 | 0 | 0 | 110 | 110 |
| Urology clinic | 50 | 0 | 0 | 30 | 0 | 0 | 0 | 80 |
| Gold Medical Diagnostic Laboratory | 0 | 0 | 50 | 0 | 0 | 0 | 0 | 50 |
| American University of Phnom penh | 0 | 0 | 0 | 0 | 0 | 30 | 0 | 30 |
|
NPHL: National Public Health Laboratory, BOM: Blue Opportunity Medical Co.,Ltd., NHealth Laboratory: Royal Phnom Penh hospital’s laboratory, DDL: Diagnostic and Detection Laboratory, KSFH: Khmer Soviet Friendship Hospital, SHCH: Sihanouk Hospital Center of Hope |
From the start of the year, CMML distributed quality controlled media
to different groups of customers around the country. Customers are
classified in four groups:
1. Government laboratory supported by DMDP: Siem Reap, Battambang,
Kampong Cham, Takeo and National Public Health Laboratory
2. Government laboratory supported by project: e.g AMR surveillance,
stool project in Battambang
3. Government laboratory purchased: interestingly with an increase in
orders from government laboratories e.g Khmer Soviet Friendship
Hospital, Cambodia China Friendship Hospital (Kossamak), National
Pediatric Hospital,…
4. Private laboratory purchased: e.g Royal Phnom Penh hospital
department of laboratory, International Laboratory, Dynamic pharma…. 5.
Supplier purchased: supplier purchase media from CMML and sell to
laboratories. e.g BOM, Dynamic…
We summarized quantity and cost in USD for the DMDP supported
laboratory by month for routine diagnostic testing.
| Cusomter Name | Media Type | Jan | Feb | Mar | Apr | May | Jun | Jul |
|---|---|---|---|---|---|---|---|---|
| Battambang | Adult Bottle | 200 (344$) | 0 | 390 (671$) | 340 (585$) | 150 (258$) | 230 (396$) | 500 (860$) |
| Child Bottle | 88 (143$) | 0 | 90 (146$) | 20 (32$) | 40 (65$) | 50 (81$) | 150 (243$) | |
| Plate | 860 (882$) | 580 (622$) | 620 (659$) | 520 (533$) | 590 (612$) | 890 (921$) | 1490 (1499$) | |
| Tube | 0 | 150 (128$) | 410 (347$) | 340 (294$) | 240 (206$) | 380 (325$) | 270 (230$) | |
| Kampong Cham | Adult Bottle | 0 | 0 | 150 (258$) | 100 (172$) | 0 | 150 (258$) | 50 (86$) |
| Child Bottle | 50 (81$) | 50 (81$) | 50 (81$) | 100 (162$) | 0 | 50 (81$) | 50 (81$) | |
| Plate | 550 (565$) | 600 (608$) | 610 (627$) | 810 (836$) | 490 (498$) | 680 (701$) | 580 (599$) | |
| Tube | 300 (247$) | 0 | 0 | 300 (247$) | 100 (85$) | 360 (294$) | 200 (161$) | |
| NPHL | Adult Bottle | 0 | 0 | 0 | 10 (17$) | 20 (34$) | 0 | 10 (17$) |
| Child Bottle | 0 | 0 | 0 | 10 (16$) | 10 (16$) | 0 | 0 | |
| Plate | 470 (456$) | 860 (800$) | 150 (161$) | 270 (261$) | 1000 (946$) | 0 | 700 (639$) | |
| Tube | 130 (108$) | 250 (175$) | 0 | 150 (109$) | 350 (260$) | 0 | 150 (109$) | |
| Siem Reap | Adult Bottle | 300 (516$) | 400 (688$) | 300 (516$) | 450 (774$) | 600 (1032$) | 500 (860$) | 500 (860$) |
| Child Bottle | 50 (81$) | 0 | 50 (81$) | 50 (81$) | 50 (81$) | 50 (81$) | 0 | |
| Plate | 1250 (1266$) | 1230 (1243$) | 1310 (1405$) | 1480 (1553$) | 1860 (1893$) | 2640 (2688$) | 1850 (1861$) | |
| Tube | 500 (427$) | 520 (442$) | 250 (214$) | 250 (214$) | 270 (234$) | 810 (688$) | 750 (641$) | |
| Takeo | Adult Bottle | 200 (344$) | 0 | 550 (946$) | 0 | 350 (602$) | 350 (602$) | 350 (602$) |
| Child Bottle | 100 (162$) | 0 | 200 (324$) | 0 | 120 (194$) | 150 (243$) | 100 (162$) | |
| Plate | 1190 (1226$) | 0 | 2330 (2445$) | 0 | 1230 (1274$) | 1960 (1893$) | 1080 (1194$) | |
| Tube | 570 (456$) | 0 | 840 (683$) | 0 | 280 (236$) | 1020 (830$) | 100 (66$) | |
| NPHL: routine sample |
Reported by CMML
26-Jul-2022